Use of this form without a CCDC 9 copyright seal constitutes an infringement of
copyright. Use of this form with a CCDC 9 copyright seal demonstrates that it is
intended by the parties to be an accurate and unamended version of CCDC 9A – 2018.
CCDC Copyright 2018
Canadian Construction Documents Committee
Statutory Declaration Standard Construction Document
of Progress Payment Distribution by Contractor CCDC 9A – 2018
To be made by the Contractor as a condition for either
□ second and subsequent progress payments; or
□ release of holdback.
Information Appearing in the Contract
Documents
Name of Project
Date of Contract: ______________________________.
Declaration
I solemnly declare that, as of the date of this declaration, I am an authorized signing officer, partner or sole proprietor of the
Contractor, and as such have authority to bind the Contractor, and have personal knowledge of the fact that all accounts for
labour, subcontracts, products, services, and construction machinery and equipment which have been incurred directly by the
Contractor in the performance of the work as required by the Contract, and for which the Owner might in any way be held
responsible, have been paid in full as required by the Contract up to and including the latest progress payment received, as
identified above, except for:
1) holdback monies properly retained,
2) payments deferred by agreement, or
3) payment withheld by reason of legitimate dispute which has been identified to the party or parties from whom payment
has been withheld.
I make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same force and effect as if
made under oath.
Declared before me in ____________________________ this _______ day of _____________________ in the year ________
City/Town and Province
_______________________________________________
Name
_______________________________________________
Title
_______________________________________________ ____________________________________________________
Signature (A Commissioner for Oaths, Notary Public, Justice of the Peace, etc.)
Application for payment number ____________________
dated __________________________________ is the last
application for payment for which the Contractor has
received payment.
Name of Contractor
Name of Owner
The making of a false or fraudulent declaration is a contravention of the
Criminal Code of Canada, and could carry, upon conviction, penalties
including fines or imprisonment.
Apply a CCDC 9
copyright seal here.
